Public Health Nutrition

Research Paper

Factors that affect the adoption and maintenance of weekly vitamin A supplementation among women in Ghana

Zelee Hilla1 c1, Betty Kirkwooda1, Carl Kendalla2, Eunice Adjeia3 p1, Paul Arthura3 and Charlotte Tawiah Agyemanga3

a1 Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK

a2 Department of International Health and Development, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA

a3 Kintampo Health Research Centre, Ghana


Objective To identify regimen, individual, community and cultural factors that affect adoption and adherence to weekly vitamin A supplementation in Ghana.

Design Fifty semi-structured interviews were conducted with women who would be eligible for vitamin A supplementation, 30 with husbands, and 13 with drug sellers, birth attendants and health workers. Six focus group discussions were also conducted with women. These interviews were followed by a 4-month capsule trial with 60 women. Data from a previously conducted communication channel survey of 332 women were also reviewed.

Setting The study was conducted in Kintampo District in central Ghana.

Subjects Participants for the semi-structured interviews and focus groups were selected from four villages and the district capital, and women in the capsule trial were selected at random from two villages.

Results Knowledge of vitamins was low and taking ‘medicines’ for long periods and when healthy is a new concept. In spite of this, long-term supplementation will be accepted if motives are explained, specific questions answered and clear instructions are given. Potential barriers included the idea of ‘doctor’ medicines as curative, false expectations of the supplement, forgetting to take the supplement, losing the supplement, travelling, lack of motivation, perceived side-effects, concerns that the supplement is really family planning or will make delivery difficult, and concerns about taking the supplement with other ‘doctor’ or herbal medicine, or when pregnant or breast-feeding, or if childless.

Conclusion Successful supplementation programmes require appropriately designed information, education and communication strategies. Designing such strategies requires pre-programme formative research to uncover barriers and facilitators for supplementation.

(Received November 02 2005)

(Accepted August 01 2006)

(Online publication March 05 2007)


c1 *Corresponding author: Email

p1 Engender Health, Accra, Ghana


‡ Deceased.